The Itch That Rashes

Myths, Misconceptions, and Education in Eczema Management

Jeanne Findlay, CPNP, CCRP, DNP; Bernard A. Cohen, MD

Disclosures

February 02, 2011

Assessment: Examination and Testing

Physical Examination

Maria is a well-nourished, well-developed child who appears her stated age and is in no acute distress.

Head: normal hair density and distribution on scalp without excoriations or scale
Ears: tympanic membranes lucent bilaterally
Nose: no rhinorrhea
Throat: without redness or exudates
Neck: no lymphadenopathy
Chest: clear bilaterally
Cardiac: regular rate and rhythm without murmur
Skin: symmetrically distributed, scaly patches in ear creases along with an ill-defined pink, scaly, excoriated patch at the nape of her neck; symmetrically distributed erythematous, scaly, excoriated patches on anterior and posterior trunk; antecubital creases of the elbows, wrists, and dorsum of hands with pink, scaly, excoriated patches; popliteal creases of the knees, shins, ankles, and tops of feet with similar irritated skin patches.

Differential Diagnosis

  • Atopic dermatitis (AD);

  • Bed bugs;

  • Scabies;

  • Psoriasis;

  • Tinea corporis; and

  • Impetigo.

Diagnostic Evaluation

Commonly ordered tests include:

  • Bacterial skin culture to rule out impetigo or superinfected skin lesions that may require oral antibiotics; and

  • Fungal skin culture to rule out dermatophyte infection and/or skin scraping for microscopy with mineral oil to rule out scabies.

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